Chest
Original ResearchInterventional PulmonologyEndobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Lymph Nodes in the Radiologically and Positron Emission Tomography-Normal Mediastinum in Patients With Lung Cancer
Section snippets
Materials and Methods
The protocol of this study was approved by the local institutional review board. All patients provided written informed consent. Between January 2004 and May 2007, consecutive patients with an indication for bronchoscopy and suspicion for NSCLC were screened for inclusion in the study. All patients did undergo a CT scan of the chest (plain and contrast enhanced) and a PET scan as part of their standard workup. Only patients without CT evidence of enlarged mediastinal lymph nodes as well as
Results
In total, 1,217 patients were evaluated until 100 patients were identified meeting criteria. Mean age was 52.4 years, and 59 were men. As stipulated, CT and PET showed evidence suggesting a tumor originating from the lung suspicious for NSCLC, without enlarged mediastinal lymph nodes and without mediastinal PET activity in all patients.
After diagnostic procedures, 97 patients were confirmed to have NSCLC (59 adenocarcinoma, 29 squamous cell cancer, and 9 adenosquamous cell cancer). This group
Discussion
In a previous published trial,19 we used EBUS-TBNA in a comparable setting. Overall, 17 patients had stage N2 or N3 disease, of which 16 cases were identified from EBUS-TBNA, and 4 patients had stage N1 disease, of which 3 cases were identified by EBUS-TBNA. The sensitivity, specificity, and negative predictive value of EBUS-TBNA for detecting malignancy were 92.3%, 100%, and 96.3%, respectively. A limitation of the study was the lack of routine PET scanning. Because PET scanning is becoming
Conclusions
The current findings suggest that EBUS-TBNA should be considered in the preoperative staging of all patients with and without mediastinal lymph node enlargement on CT scan and with or without PET activity in the mediastinum. EBUS TBNA could be an obvious choice for the primary procedure because it is well tolerated, carries minimal morbidity, and allows for additional pulmonary procedures in the same setting. Further studies are needed to compare the different invasive and noninvasive staging
References (34)
- et al.
Noninvasive staging of non-small cell lung cancer: ACCP evidence-based clinical practice guidelines (second edition)
Chest
(2007) - et al.
Noninvasive staging of non-small cell lung cancer: a review of the current evidence
Chest
(2003) - et al.
Lung cancer staging
J Surg Res
(2004) - et al.
Prognostic value of fluorodeoxyglucose positron emission tomography in non-small cell lung cancer: a review
J Thorac Oncol
(2006) - et al.
Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (second edition)
Chest
(2007) - et al.
Surgical assessment and intraoperative management of mediastinal lymph nodes in non-small cell lung cancer
Ann Thorac Surg
(2007) - et al.
Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis
Chest
(2007) - et al.
Endobronchial ultrasonography: current status and future directions
J Thorac Oncol
(2007) - et al.
Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer
Chest
(2006) - et al.
Is it possible to differentiate malignant mediastinal nodes from benign nodes by size? Reevaluation by CT, transesophageal echocardiography, and nodal specimen
Chest
(1996)
Mediastinoscopy in patients with clinical stage I non-small cell lung cancer
Ann Thorac Surg
Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography
Ann Thorac Surg
Endoscopic ultrasound in non-small cell lung cancer and negative mediastinum on computed tomography
Am J Respir Crit Care Med
Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer
J Thorac Cardiovasc Surg
Multidisciplinary management of lung cancer
N Engl J Med
Positron emission tomography imaging in nonsmall-cell lung cancer
Cancer
Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: analysis of 1145 lymph nodes
Lung Cancer
Cited by (316)
Endobronchial Ultrasound for Mediastinal Staging in Lung Cancer
2021, Encyclopedia of Respiratory Medicine, Second Edition
The institutions or affiliated medical schools of the authors have received unrestricted grant support from Olympus Corporation for continuing medical education activities, and the endobronchial ultrasound imaging components are on loan in the institutions. The authors have not received any direct financial support.